Psychiatrist Thomas Szasz has picked up a number of vulgar Americanisms in the 44 years since he came here from his native Hungary, but there is still one everyday phrase he refuses to adopt--one so offensive, to his ears, that he has sworn his life to the cause of purging it from the language.
The phrase is "mental illness." Szasz would be the first to admit that some people get along less smoothly in life than other people, and that they do illogical and destructive things in the course of their nonsmooth lives, like swallowing barbiturates, brutalizing infants and shooting presidents. But the question, in his mind, is whether such people are ipso facto "ill"--suffering from a condition to be identified and treated by trained members of the medical profession--or whether they have merely bungled life in ways that psychiatrists, yoga instructors, anthropologists, novelists and bartender-philosophers may all be equally well or poorly equipped to explain.
Take the case of would-be presidential assassin John W. Hinckley Jr. To call someone like Hinckley crazy "is a tautology," says Szasz, because "you are simply plumbing the meaning of what people mean by 'crazy' today in America." But he rejects the equation of craziness and nonresponsibility. The prosecution argument (that Hinckley was sane and responsible when he did his deed) and the defense argument (that he was insane and nonresponsible) are "symmetrical lies" and "equally ridiculous," he says. Both sides are engaged in "bamboozling the jury that there is something medical and scientific going on."
And the bamboozle, according to Szasz, is one of the tried-and-true techniques of psychiatry. "I would say that the history of psychiatry is very largely the history of lies," he says in his paprika-spiced accent, the words popping across his small office with the force of billiard shots. "The people who make the lies may believe them, but they are lies nevertheless. Patients lie and psychiatrists lie. When the patients lie, we call them delusions. When the psychiatrists lie, we call them psychiatric theories."
"In science, in medicine," he says, "a physician makes a distinction between a known disease and a putative disease--that is, 'I think this is a disease, but I haven't got any evidence.' Psychiatrists don't make the distinction. Psychiatrists claim that schizophrenia, depression, alcoholism, smoking and so on are diseases--but where's the evidence? Every 10 years they have different evidence. Electrical, chemical, genetic and so forth. Science is based on honesty, and the one thing we know about psychiatrists is that they lie all the time. Lobotomy was a lie. Electric shock was a lie. What drugs do, they're all lies. They create the impression that these people are scientists just like people who work on transistors and rockets, instead of that they are dealing with human affairs . . .
"In some ways mental illness is very similar to the idea of being possessed by devils. People think there is such great progress, but it's really not very different. In religion there is the business of getting this thing out of the person--with exorcism, prayer and so forth. Now we get this thing out of a person with psychotherapy, with drugs, with electric shock."
Leading off with a soft "S," rhyming correctly with coup de gra ce (and falsely with vichyssoise), Szasz's name has appeared on 17 books and on hundreds of essays, articles and monographs adding up to an encyclopedic assault on his profession. And he has written almost every impassioned word in the chilly noncosmopolis of Syracuse, N.Y., where, since 1956, he has been a teacher and practitioner of psychiatry at the Upstate Medical Center of the State University of New York.
Now the lay person might find it odd that someone so dubious about psychiatry--and about its founding father, Sigmund Freud, whom Szasz refers to as "a master con man," "an out-and-out fraud" and "a fraudulent phrenologist and crypto-Jewish cult leader"--should have chosen this particular livelihood. Some of Szasz's fellow psychiatrists find it more than odd and, in their defense, they have excellent grounds for wishing he had gone into some other field--like sheep ranching or heavy construction.
For ever since "The Myth of Mental Illness," the 1960 book in which Szasz first itemized his complaints, he has been renting his services as an expert witness (at the basic rate of $2,000 a day and expenses) to any mental patient attempting to gain his freedom and/or sue the psychiatrist involved in taking it away. "And I'm proud of this," says Szasz. "I look upon this strictly as slavery. I don't believe that in a free society anybody should be deprived of his liberty on any ground other than accusation, trial and being found guilty of a criminal charge"--a view that, thanks partly to his efforts, has prevailed with many a judge and jury in recent years, leading to many a verdict against psychiatrists who did business under the old morality.
"I have no objection to psychiatry between consenting adults," says Szasz, "just as I am in favor of sex between consenting adults and religion between consenting adults." But "I don't think psychiatry would survive if it were restricted to consenting interventions, because it is based entirely on slavery, ideologically and practically and economically. If you took out coercion--government power, on the one hand, and government money, on the other--all of the psychiatrists in Washington would be on the bread line."
Or is that too rash? Having issued his pronouncement--a characteristic damn-the-torpedoes, full-speed-ahead Szaszism--he pauses for an uncharacteristic moment of reflection, followed by a positively aberrational amendment: "All but a dozen. I don't think more than 12 psychiatrists could make a living in Washington if people would have to pay for the service just as they have to pay for lettuce or for a martini."
Survival in the '60s
In the early '60s, these attitudes and the actions that accompanied them led to what Szasz calls the "big blow-up," commencing when the New York State commissioner of mental hygiene delicately advised Szasz's employer, the State University of New York, to reevaluate his services. " "I felt certain that I would lose my job until the very end," says Szasz, crediting his survival only to the fact that he had tenure and "was as intelligent and as pugnacious a Hungarian Jew as I am."
All that is "ancient history" now. His colleagues have grown accustomed to his face, and while they're about it, to his quick tongue, to his smartly tailored wardrobe, and to a group of manual and digital habits that, in anyone who wasn't a psychiatrist, would probably be called "neurotic"--e.g., scraping off pieces of Molson Ale label with a fingernail and stuffing them, one by one, into the empty bottle.
But 20 years after his trial by fire, Szasz is still burning. Bring up the Hinckley trial and the issue of the psychiatrist's role in the criminal justice system, and feel the heat: "Everybody wants to achieve something," he says. "Not one person is interested in the truth in that trial." The true purpose of the debate over Hinckley's sanity, he says, is to satisfy "contemporary society's enormous unwillingness to be straightforward in assigning blame and punishing people. Psychiatry relieves us of thinking about these questions. It's a kind of mental opium. I look upon psychiatric testimony in the Hinckley case and generally as equivalent to somebody drinking three martinis or four martinis before he goes on the Monte Carlo auto race. This is not the way to race a car. This is not the way to think about the weightiest moral questions that this jury is supposed to deliberate."
The senior Hinckleys, in Szasz's view, used psychiatry to buy a form of medical absolution before disowning responsibility for their son. "And during the last month, you know, Hinckley's parents were running around helping Haitian refugees," he adds in wide-eyed amazement. "It's like something out of Voltaire!"
Applying his analytic powers to Hinckley himself, Szasz notes that the attack on President Reagan occurred the same day Hinckley's parents had appointed for his self-sufficiency. This was the son's way of saying, as Szasz interprets it, "You're not going to get rid of me this easy." But Szasz has no wish to inject his analysis into the judicial process, and he is correspondingly irate about the testimony of a California prison psychiatrist that Sirhan Sirhan should be paroled. "Why didn't the prison tea-leaf reader testify?" he asks. "Why doesn't the cook testify as an expert that he likes to eat, therefore he should be released." In any case, "It's obscene to debate whether to set him free. How would the average Jew feel about setting Hitler free after he had served for 30 years? These are moral issues, they're not logical issues."
The medical model for examining problems of the mind arose, Szasz believes, for sound historical reasons--to bring an element of tolerance and compassion to the treatment of human aberration. But in the battle for acceptance, the theorists of Freud's time resorted to what Szasz regards as deceptive advertising--couching guesses and flights of fancy in the language of hard scientific fact--and that process, he argues, has taken on a life of its own.
"The American Psychiatric Association is using I don't know how many millions of dollars of its money," he says, "for a legal effort to make sure that only psychiatrists get government funds, and not psychologists or social workers, no matter how competent. Erik Erikson or Bruno Bettelheim? They're not competent, they're not MDs. The medical model is in the last analysis a guild model, a labor union model. It's a Jimmy Hoffa model. Who can drive a truck? It doesn't matter how well you drive it. It's who belongs to the club . . . Psychiatry is--they themselves have a term for it--re-medicalizing. They're trying to define themselves as more and more medical because they suspect, and perhaps rightly, that there will be more and more government payments, and they want to be sure that they are at the right end of the trough."
The leaders of the American psychiatric establishment have had long experience in defending themselves against Szasz's artillery attacks, and they do so with impressive calm. "He's a practicing psychiatrist who has a point of view which is expressed vividly and with great force," says Miles F. Shore, professor of psychiatry at Harvard. "Any live field which is dealing with serious issues has people with a variety of points of view. In this country, they have a right to be heard, to be evaluated and to help keep people's thinking straight." As for Szasz's comments on APA lobbying, "I don't know that the APA has tried to derogate or play down other mental health professions so much as it has tried to present to public bodies what psychiatrists do in a positive sense," says Shore, a member of the APA's public affairs board. "Other professional groups do that too. I think that's a legitimate activity of a professional group."
The attempt to place the imprimatur of science upon essentially subjective skills and causes has become more and more pervasive in recent years, Szasz believes, leading to a broad menace he calls "the medicalization of life." Consider--from the Szaszian perspective--the evidence:
* Schoolchildren are routinely given amphetamines--"government-issued poison," according to Szasz--for hyperactivity, while criminals and mental patients receive state-subsidized Thorazine, Valium and other psychoactive drugs--a "chemical straitjacket." "A Jehovah's Witness has the right to refuse a blood transfusion when it is immediately life-saving," he says, "but a schizophrenic doesn't have the right to refuse Thorazine, which is not life-saving."
* The APA has discovered the existence of several new mental illnesses, including "Tobacco Use Disorder" and "Academic Underachievement Disorder," defining the latter as "a clinical picture in which the predominant disturbance is failure to achieve in most school tasks despite adequate intellectual capacity, supportive and encouraging social environment, and apparent effort . . . The disorder is relatively common and found equally in males and females."
* The sexologists William Masters and Virginia Johnson prescribe masturbation as therapy--for a new ailment they have christened "masturbatory orgasmic deficiency." "The therapeutic powers of masturbation," Szasz has written (in his most recent book, "Sex By Prescription"), "are now propounded with the same smug professional conviction with which its pathogenic powers had been propounded in the past. Because the antimasturbators wanted to make the practice appear wicked, they called it self-abuse; because the pro-masturbators want to make it appear virtuous, they call it self-pleasuring."
In these bulletins, Szasz sees a growing infatuation with the idea that "decisions are somehow secreted by the brain just as sugar is secreted by the kidney when you have diabetes. It's not a decision. It comes out . . . I do believe in free will. I believe that what people do cannot be the proper subject matter of some kind of deterministic investigation. People can make choices and ought to be held responsible in various ways for what they do in life."
Psychotherapy can help people make those choices, says Szasz, "but I mean psychotherapy in the old-fashioned common-sense term--people talking seriously about their life's problems. Freud didn't discover that. The Socratic dialogue would be a much better example." Unfortunately, he adds, this kind of activity is discouraged by the presumption that every problem is a malady demanding a doctor. The downgrading of free will by psychiatrists and others becomes, in short, a "self-fulfilling prophecy."
People with problems, says Szasz, should be free to seek help from the source of their choosing--or no help at all, if they prefer. As a result of such sentiments, he has been portrayed as a cold-blooded libertarian who looks with approval on all human quirks and misfortunes. But Szasz sees himself as "someone who is trying to think reasonably and compassionately about very complicated problems." If people want to outlaw something or lend it an official endorsement, he says, they should be straightforward about what they are doing rather than shroud their decisions in "pseudo-scientific reasons."
He does not claim that all behavior is equally good, he insists, only that "there aren't two kinds of people--mentally ill and everybody else. There are just people." That is psychiatry's underlying mistake, in the Szaszian analysis. "I like to compare it to the man who gets up in the morning and starts to button his shirt," he says. "If you button the first buttonhole to the second button, it doesn't matter how careful you are the rest of the way."